CAJ | 학술논문

目的分析新生儿B族链球菌脑膜炎的临床特点、药敏情况及随访结果.方法对2005年1月至2013年5月温州医科大学附属育英儿童医院新生儿科收治的13例新生儿B族链球菌脑膜炎的临床资料进行回顾性分析.结果新生儿B族链球菌脑膜炎以发热、少食或喂养困难、惊厥、反应差等临床表现多见.3例早发型患儿母亲产前有应用抗生素.C反应蛋白升高者13例,其中病初即升高11例.13例患儿治愈7例,好转自动出院4例,因严重并发症放弃后死亡2例.治愈病例住院时间(47 ±21)d.13例患儿中并发低钠血症5例次,颅内出血3例次,脑室扩张3例次,硬膜下积液2例次,脑积水2例次,感染性休克2例次,脑疝1例次,脑软化1例次.出院1个月后1例早发型伴脑积水早产儿在家中死亡.7例随访至10 ～24个月:3例早发型患儿中,生长发育正常2例,运动发育落后1例;4例晚发型患儿中,生长发育正常1例,运动发育落后2例,癫痫发作1例.B族链球菌对青霉素及利奈唑胺均敏感(13/13、9/9),对左氧氟沙星、氨苄青霉素及万古霉素敏感率分别为11/12、9/10和8/13.结论新生儿B族链球菌脑膜炎临床表现非特异性,住院时间长,易出现神经系统并发症和后遗症.C反应蛋白在病初即有较高的敏感性.产前预防、早期诊断和治疗很重要,治疗应首选大剂量青霉素,对难治性病例可选用利奈唑胺等治疗.
목적 분석신생인B족련구균뇌막염적림상특점、약민정황급수방결과.방법 대2005년1월지2013년5월온주의과대학부속육영인동의원신생인과수치적13례신생인B족련구균뇌막염적림상자료진행회고성분석.결과 신생인B족련구균뇌막염이발열、소식혹위양곤난、량궐、반응차등림상표현다견.3례조발형환인모친산전유응용항생소.C반응단백승고자13례,기중병초즉승고11례.13례환인치유7례,호전자동출원4례,인엄중병발증방기후사망2례.치유병례주원시간(47 ±21)d.13례환인중병발저납혈증5례차,로내출혈3례차,뇌실확장3례차,경막하적액2례차,뇌적수2례차,감염성휴극2례차,뇌산1례차,뇌연화1례차.출원1개월후1례조발형반뇌적수조산인재가중사망.7례수방지10 ～24개월:3례조발형환인중,생장발육정상2례,운동발육락후1례;4례만발형환인중,생장발육정상1례,운동발육락후2례,전간발작1례.B족련구균대청매소급리내서알균민감(13/13、9/9),대좌양불사성、안변청매소급만고매소민감솔분별위11/12、9/10화8/13.결론 신생인B족련구균뇌막염림상표현비특이성,주원시간장,역출현신경계통병발증화후유증.C반응단백재병초즉유교고적민감성.산전예방、조기진단화치료흔중요,치료응수선대제량청매소,대난치성병례가선용리내서알등치료.
Objective To study the clinical characteristics,antibiotics sensitivity and outcome of group B streptococcus (GBS) meningitis in neonates in order to provide the guide for early diagnosis and appropriate treatment.Method A retrospective review was performed and a total of 13 cases of neonatal purulent meningitis caused by GBS were identified in the Neonatal Intensive Care Unit of Yuying Children's Hospital of Wenzhou Medical University from January 1,2005 to May 31,2013.The clinical characteristics,antibiotics sensitivity test results and outcome were analyzed.Result Fever,poor feeding,seizure and lethargy were common clinical signs of neonatal purulent meningitis caused by GBS.Three cases of early onset GBS meningitis received prepartum antibiotics.All 13 cases had abnormal C-reactive protein (CRP) level,and 11 cases had increased CRP within hours after admission.Of the 13 patients,7 were cured,4 discharged with improvement,2 patients died during hospitalization after being given up because of serious complication.The average length of stay for recovered patients was (47 ±21)d.Acute complications mainly included hyponatremia (5 cases),intracranial hemorrhage (3 cases),ventriculomegaly (3 cases),subdural collection (2 cases),hydrocephalus (2 cases),septic shock (2 cases),cerebral hernia (1 case),encephalomalacia (1 case).One preterm patient with early onset GBS meningitis died 1 month after hospital discharge.Among 7 survivors with 10-24 months follow-up,3 were early onset GBS meningitis,2 with normal results of neurologic examination,1 with delayed motor development,4 were late onset GBS meningitis,1 with normal results of neurologic examination,3 were neurologically impaired with manifestations including delayed motor development (2 cases) and seizures (1 case).All the GBS strains were sensitive to penicillin and linezolid (13/13,10/10),the susceptibility to levofloxacin,ampicillin and vancomycin were 11/12,9/10,8/13 respectively.Conclusion The clinical manifestations of neonatal purulent meningitis caused by GBS are usually non-specific.It is associated with long hospitalization,neurological impairments and sequelae.Monitoring of serum CRP level is valuable for early diagnosis.Antepartum prophylaxis,early diagnosis and therapy are vital.Large dose penicillin is the priority choice to treat the neonatal purulent meningitis caused by GBS,linezolid should be used in intractable cases.